The dangers of euthanasia-on-demand

By expanding access to euthanasia, the Netherlands puts society's most vulnerable at risk.

By expanding access to euthanasia, the Netherlands puts society's most vulnerable at risk.

Willem Lemmens, Trudo Lemmens, Arthur Caplan

If the Dutch Cabinet gets what it wants, citizens who feel they have a "completed life" soon will be able to request public support for help in ending their lives. It is a frightening precedent that other nations ought not follow, and a policy the Dutch ought to reject.

In a letter to Parliament, the ministers of health and justice propose a new law as a "solution" to the growing number of people who feel "tired of life" but currently do not have access to euthanasia — a practice that is already widely accessible in the Netherlands.

A special "counselor in dying" (stervensbegeleider) will be charged with checking whether the request flows from a genuine, persistent desire to die and a sense of "completed life." How to judge this objectively is not clear. But the ministers are confident that the law will make requests "verifiable and transparent." Even though they go out of their way to differentiate the proposal from the current euthanasia law, the new proposal clearly sits on a continuum that the Dutch have been sliding down — incredibly — toward full state support for euthanasia on demand.

As recently as February 2016, a Dutch parliamentary committee recommended against such a move. The committee's chair even referred to the "counselor in dying" concept as a "creepy idea." The committee pointed out that most Dutch elderly people who want euthanasia can already ask for their life to be ended, since they often suffer from an untreatable medical condition. It also warned the practice would be hard to control.

Some ministers in the Cabinet somehow believe that this new practice of aid-in-dying outside the medical context can easily be controlled. But reports from the Netherlands and Belgium, countries with the world's most liberal right-to-die regimes, reveal the challenge of containing euthanasia even within the medical sphere.

In both countries euthanasia has significantly expanded, in terms of numbers and in terms of who can have access. In the Netherlands, more than 5,000 people are now euthanized per year. In Belgium, it has risen to 2,021 in 2015 from 347 in 2004.

Euthanasia in both countries is increasingly provided outside the paradigm of unbearable physical, disease-related suffering at the end of life. Particularly significant, even if still limited, is the increase in those who are euthanized because of psychiatric disorders: not just severe depression, but also schizophrenia, anxiety, autism, anorexia, PTSD and even profound grief.

Euthanasia has been offered to couples who want to die together, people who are disabled and increasingly to people who are just tired of life. The startlingly subjective access criteria, coupled with the option to shop for a lenient physician, appear to make it exceedingly easy to fulfill the existing legal criteria. For the same reason, regulatory findings of noncompliance and prosecution are almost nonexistent since the overall criteria are so easy to satisfy.

The "completed life" proposal is a further expansion of the current euthanasia practice while proliferating a whole new culture of dying. Should the Netherlands take the next step, the active ending of a life "on request" of those who feel life is no longer worth living will become a daily reality.

Aid in suicide, facilitated by the state, is the logical consequence of a fetishizing of choice. How can one not see the danger of this shift? What the Dutch Cabinet proposes may affect people who are lonely and isolated or fear becoming a burden to society. It glosses over the dangerous financial and emotional pressures that might increase once the elderly, particularly those who are disadvantaged, are offered a quick and smooth exit. The Dutch Socialist and Christian Democratic parties have already expressed their worry about legalizing assisted suicide against the backdrop of cost savings in health care.

More generally, a whole culture of care might gradually erode: The commitment to protect life, especially of those who are disabled and dependent, might increasingly be weighed against the supposed costs and burden of loss of autonomy and decreasing quality of life. The notion of a "completed life" erroneously suggests that life's value is something measurable, not only for those whose life is at stake, but also for their families and communities, and for the policymakers who would have to organize this new aid-in-dying practice.

The developments in the Netherlands should make countries struggling to regulate physician-assisted dying, such as the U.S. and Canada, pause about which road to travel and how fast. They should realize that all-too-easy access to state-supported life-ending measures resulting from regulations without significant constraints risks trivializing the practice — and subtly gnaws at a society's commitment to protect the most vulnerable members of society. Broad access to state-sanctioned suicide risks endangering the weak, the fragile, the different and the poor. This is not where any society ought to go.

Willem Lemmens is chair of the department of philosophy at the University of Antwerp; Trudo Lemmens is the Dr. William M. Scholl Chair in Health Law and Policy, faculty of law and of the Dalla Lana School of Public Health, University of Toronto; Arthur Caplan is a professor of bioethics at New York University Langone Medical Center.